Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 In a message dated 10/09/2001 4:25:39 PM Pacific Daylight Time, peppler@... writes: << 2. Insurance companies these days pay only a percentage of what doctors and hospitals charge, often only a small fraction, and the docs and hospitals have to accept whatever they pay and, especially in the case of hospitals, it often does not even cover their costs. >> Don't get me wrong. I understand Dr. R not accepting insurance. I know from personal experience as do most of you that dealing with insurance companies is a pain in the rear, to say the least. However, regarding the percentage that you're talking about that the insurance companies pay. I know with my insurance the DO disallow charges ONLY IF you're " In Network, " and ONLY IF that doctor and/or hospital have signed an agreement with the insurance company. If there is no agreement to accept the allowed charges then the patient would be responsible for whatever is above what the insurance allows. So my point is... If a doctor and/or hospital is only getting a percentage of what the insurance allows then the doctor and hospital would have had to agree to that in writing to accept the allowable amount. And this wouldn't even apply to people who are out of network. You may be right that this percentage don't always cover the doctor and hospital's cost, however, I find that hard to believe. With the cost of health care I do not think that the doctor's or insurance companies are getting a raw deal. I will close by saying I DO understand Dr. R not wanting to mess with the hassle of insurance, especially with his work load. And what I said above is the way my insurance company deals with disallowed charges (in and out of network), I cannot speak for all insurance companies. But that is the way mine works. And trust me when I say that my doctor's here and the hospital I use is NOT getting short changed in anyway. I think the cost BEFORE any charges are disallowed are outlandish! I feel SO sorry for people that don't have insurance and have to pay these outrageous cost. It's no wonder some people are forced to file bankruptcy on medical bills. My insurance would not cover my surgery, so I was self-pay. For me, where there's a will - - - there was a way! Take care! in OK -108 mgb 3/29/01 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 In a message dated 10/09/2001 4:48:30 PM Pacific Daylight Time, nvalmassoi@... writes: << I would ADD that it doesn't mean that insurance won't be used. It just means that the burden is on the patient. You have to file your own insurance. If your insurance covers wls...you will still get reimbursed. You have to be able to pay upfront, however which is a huge burden for some people. The doctor is just not involved. BUT...where there is a will, there is a way. I know lots of people who wouldn't seem to have the means to pay for this surgery who somehow find a way...God opens doors for all of us. My two cents.... >> And if you KNOW that you're insurance WILL cover surgery, then most people could always get a loan and pay that loan off when the insurance company pays you. Just something to think about. in OK Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 In a message dated 10/09/2001 4:48:30 PM Pacific Daylight Time, nvalmassoi@... writes: << I know lots of people who wouldn't seem to have the means to pay for this surgery who somehow find a way...God opens doors for all of us. >> I agree with that statement! God opened doors for me that I didn't even know were there. I thought without insurance covering my surgery that I would NEVER be able to have this surgery. But I'm now just over 6 months post op. Not only was that door opened and my life changed.... I was in the VERY last group of people (there were four of us that day) that had surgery since this all started. March 29, 2001 was the very last day that Dr. R has performed these surgeries. So not only did God provide the funds for me to have this surgery, He also allowed my surgery to be carried out on 3/29/01. If I had been scheduled even a day later, then I wouldn't have been able to have it like so many others. Don't think I haven't thanked God for that miracle! I feel very fortunate. I prayed about this surgery for a long time, and God does answer prayers! Hugs, in OK MGB 3/29/01 -108 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 shelley, I had the procedure in 8/99 and have lost 167 lbs. I read all these references to Dr. R's problems but I don't know what happened. What happened?!! thanks. gary Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 Thank you, . I wish you all the best! in OK In a message dated 10/09/2001 6:29:58 PM Pacific Daylight Time, nvalmassoi@... writes: << How neat to hear your story. God does answer prayers. I was self pay too and I will be self pay again when I have a revision. It was hard to accept but I too feel so lucky that I got to have this surgery even if my success will require another surgery to be REALLY successful. The truth is if Dr. R had said, I can only get 115 pounds off of you, I would have said go for it...I have NEVER regretted the decision to have this surgery and I look forward to the day I can have a revision. My life is worth whatever it takes... >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 Well, . I don't know that I'm going to be much help to you. All I know is that there was a problem with the way he was coding stuff for the insurance companies. My understanding is (and someone correct me if I'm wrong) that there is not a code for the MGB. So Dr. R was using the code for RNY and then attaching a detailed description of the procedure. Not his fault if the insurance companies don't look at that. Anyway, our friend (HA) T. brought this to the insurance companies attention in an effort to cause trouble for Dr. R. Well, we see the result. Like I said, if this isn't right, someone PLEASE correct me. But this is my understanding of it all. Congratulations on your 167 pound loss. That's GREAT! Are you still losing or have you been where you're at for a while? in OK MGB 3/29/01 303/195 -108 In a message dated 10/09/2001 6:46:25 PM Pacific Daylight Time, jackie1599@... writes: << shelley, I had the procedure in 8/99 and have lost 167 lbs. I read all these references to Dr. R's problems but I don't know what happened. What happened?!! thanks. gary >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 I would ADD that it doesn't mean that insurance won't be used. It just means that the burden is on the patient. You have to file your own insurance. If your insurance covers wls...you will still get reimbursed. You have to be able to pay upfront, however which is a huge burden for some people. The doctor is just not involved. BUT...where there is a will, there is a way. I know lots of people who wouldn't seem to have the means to pay for this surgery who somehow find a way...God opens doors for all of us. My two cents.... Re: paying customers I think there are two reasons that he is not going to take insurance any more. 1. The hassle of applying, fighting denials, then filing, etc. take up too much time and manpower. It makes too much overhead and too many headaches in his practice. 2. Insurance companies these days pay only a percentage of what doctors and hospitals charge, often only a small fraction, and the docs and hospitals have to accept whatever they pay and, especially in the case of hospitals, it often does not even cover their costs. The return on the effort of collecting insurance is quite often not worth it, especially when you have more patients than you can handle. I know it does not seem fair, but that is life under the new insurance practices. Pat Eppler paying customers Why is he is not taking insurance cutomers. Why is he making anyone file with the insurance company for a refund. Why does everyone have to pay up front. If my insurance would not have paid for my surgery, I would still be 276 or more at this date. I could have never come up with that type of money. Some one please make me understand. Wills -120 pending PS approval Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 How neat to hear your story. God does answer prayers. I was self pay too and I will be self pay again when I have a revision. It was hard to accept but I too feel so lucky that I got to have this surgery even if my success will require another surgery to be REALLY successful. The truth is if Dr. R had said, I can only get 115 pounds off of you, I would have said go for it...I have NEVER regretted the decision to have this surgery and I look forward to the day I can have a revision. My life is worth whatever it takes... V Re: paying customers In a message dated 10/09/2001 4:48:30 PM Pacific Daylight Time, nvalmassoi@... writes: << I know lots of people who wouldn't seem to have the means to pay for this surgery who somehow find a way...God opens doors for all of us. >> I agree with that statement! God opened doors for me that I didn't even know w ere there. I thought without insurance covering my surgery that I would NEVER be able to have this surgery. But I'm now just over 6 months post op. Not only was that door opened and my life changed.... I was in the VERY last group of people (there were four of us that day) that had surgery since this all started. March 29, 2001 was the very last day that Dr. R has performed these surgeries. So not only did God provide the funds for me to have this surgery, He also allowed my surgery to be carried out on 3/29/01. If I had been scheduled even a day later, then I wouldn't have been able to have it like so many others. Don't think I haven't thanked God for that miracle! I feel very fortunate. I prayed about this surgery for a long time, and God does answer prayers! Hugs, in OK MGB 3/29/01 -108 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 I think there are two reasons that he is not going to take insurance any more. 1. The hassle of applying, fighting denials, then filing, etc. take up too much time and manpower. It makes too much overhead and too many headaches in his practice. 2. Insurance companies these days pay only a percentage of what doctors and hospitals charge, often only a small fraction, and the docs and hospitals have to accept whatever they pay and, especially in the case of hospitals, it often does not even cover their costs. The return on the effort of collecting insurance is quite often not worth it, especially when you have more patients than you can handle. I know it does not seem fair, but that is life under the new insurance practices. Pat Eppler paying customers Why is he is not taking insurance cutomers. Why is he making anyone file with the insurance company for a refund. Why does everyone have to pay up front. If my insurance would not have paid for my surgery, I would still be 276 or more at this date. I could have never come up with that type of money. Some one please make me understand. Wills -120 pending PS approval Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 9, 2001 Report Share Posted October 9, 2001 Dr. Rutledge told me that the FBI had cleared him of any wrongdoing on the insurance front. > Well, . I don't know that I'm going to be much help to you. All I know > is that there was a problem with the way he was coding stuff for the > insurance companies. My understanding is (and someone correct me if I'm > wrong) that there is not a code for the MGB. So Dr. R was using the code for > RNY and then attaching a detailed description of the procedure. Not his > fault if the insurance companies don't look at that. Anyway, our friend (HA) > T. brought this to the insurance companies attention in an effort to > cause trouble for Dr. R. Well, we see the result. > > Like I said, if this isn't right, someone PLEASE correct me. But this is my > understanding of it all. > > Congratulations on your 167 pound loss. That's GREAT! Are you still losing > or have you been where you're at for a while? > > in OK > MGB 3/29/01 > 303/195 -108 > > In a message dated 10/09/2001 6:46:25 PM Pacific Daylight Time, > jackie1599@a... writes: > > << shelley, I had the procedure in 8/99 and have lost 167 lbs. I read all > these > references to Dr. R's problems but I don't know what happened. What > happened?!! thanks. gary > >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 I feel that insurance will still take care of a great deal of the amounts people have to pay they will be pre-approved and there will not be an agreed amount. If the bill is $4000 and your insurance pays 80% of a non participating Dr.'s fee then your portion would be $800.00. They may work something out with a bank for a 60 day note or something of that order. The Dr.'s office will have to be very prompt in filling so the 80% will be back before the 6 month note is due. This does not mean the hospital bill would not be covered by insurance. It depends on what type of arrangement your insurance company has with that hospital to amounts and how it would have to be handled. I just wish the media had to print retractions the same size as the original and as much publicity was given the retraction as the original article or news broadcast. People just don't realize what damage has been done to someone until they sit in their chair or wear their shoes. When accusations are falsely made that person should be held accountable for the consequences. I know this is not the american way but we all know the american way is not always the only way Phyllis Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 , I feel the same way, now only the elite and rich folks will be able to have this surgery via Dr. R. I guess us poor folks need to go to another doctor. I am assuming that because of and her witch hunt after him, we are the ones who will suffer. But I guess the Doctor has incurred lots and lots of costs in lawyers fees, etc., not to mention interruption of his practice and income, and cannot any longer take the small amounts insurance pays and sometimes they don't pay at all and he looses money. I guess there are two sides to everything, I just feel badly for folks who aren't wealthy and cannot come up with almost $20,000 cash. paying customers Why is he is not taking insurance cutomers. Why is he making anyone file with the insurance company for a refund. Why does everyone have to pay up front. If my insurance would not have paid for my surgery, I would still be 276 or more at this date. I could have never come up with that type of money. Some one please make me understand. Wills -120 pending PS approval Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 I don't think they have the means at all, I think they sacrifice their homes, retirement accounts, credit rating, etc., and ability to pay other bills. I believe the sacrifice is worth it and I would have done it to save my life. however, coming up with funds and having the means are usually at a great sacrifice somewhere else in their lives. Spoken as a single parent for many years who found a way on a daily basis. Re: paying customers I think there are two reasons that he is not going to take insurance any more. 1. The hassle of applying, fighting denials, then filing, etc. take up too much time and manpower. It makes too much overhead and too many headaches in his practice. 2. Insurance companies these days pay only a percentage of what doctors and hospitals charge, often only a small fraction, and the docs and hospitals have to accept whatever they pay and, especially in the case of hospitals, it often does not even cover their costs. The return on the effort of collecting insurance is quite often not worth it, especially when you have more patients than you can handle. I know it does not seem fair, but that is life under the new insurance practices. Pat Eppler paying customers Why is he is not taking insurance cutomers. Why is he making anyone file with the insurance company for a refund. Why does everyone have to pay up front. If my insurance would not have paid for my surgery, I would still be 276 or more at this date. I could have never come up with that type of money. Some one please make me understand. Wills -120 pending PS approval Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 , the loan will be $20,000 the insurance coverage would probably be 1/2 of that so you still incur a great cost, albeit worth it in my mind. Re: paying customers In a message dated 10/09/2001 4:48:30 PM Pacific Daylight Time, nvalmassoi@... writes: << I would ADD that it doesn't mean that insurance won't be used. It just means that the burden is on the patient. You have to file your own insurance. If your insurance covers wls...you will still get reimbursed. You have to be able to pay upfront, however which is a huge burden for some people. The doctor is just not involved. BUT...where there is a will, there is a way. I know lots of people who wouldn't seem to have the means to pay for this surgery who somehow find a way...God opens doors for all of us. My two cents.... >> And if you KNOW that you're insurance WILL cover surgery, then most people could always get a loan and pay that loan off when the insurance company pays you. Just something to think about. in OK Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 Hi , Dr. R is not taking insurance at this time because of all the problems with BCBS - this situation is an ongoing battle that will take some time to resolve. I don't blame him at all. BCBS has indeed contributed to this negative publicity which has impacted his medical practice, his patients, and perhaps on his family as well. So the primary focus is to get things up and running so that he can continue to help those in need. I agree it will be very difficult without insurance. At this point I do not know how I will come up the funds necessary to have this revision, but some how, come hill or high water I will do it! And who knows things may change in the future, where insurance will cover this procedure (as they should), without all the battling that has to occur for most patients now. And perhaps his office could re-consider accepting insurance. Sorry, I'm getting carried away here....I'll get off my soap-box now! LOL BTW, how's the new job going? Hope to see you sometime soon sweetie....I miss seeing your smiling face! {hugs} wrote: > Why is he is not taking insurance cutomers. Why is he making anyone file with the insurance company for a refund. Why does everyone have to pay up front. If my insurance would not have paid for my surgery, I would still be 276 or more at this date. I could have never come up with that type of money. Some one please make me understand. Wills -120 pending PS approval Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 I think they should put a wonderful picture of him on the front page with a public appology. And the one not to be mentioned should be shown beside him with one ofthose little magnetic pictures that kids use to draw mustashes and hair on a bald figure. We could all decorate her as we see her. Horns and all. Phyllis Oh yes I forgot esecially make her fat and mad. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 Ahhh. Didn't know how that works, since my insurance didn't cover any of the costs. Is the cost really up from about $12,000 to $20,000? I did get in by the skin of my teeth! in OK _____________________________________________ , the loan will be $20,000 the insurance coverage would probably be 1/2 of that so you still incur a great cost, albeit worth it in my mind. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 , Well said! S. wrote: > I would ADD that it doesn't mean that insurance won't be used. It just means that the burden is on the patient. You have to file your own insurance. If your insurance covers wls...you will still get reimbursed. You have to be able to pay upfront, however which is a huge burden for some people. The doctor is just not involved. BUT...where there is a will, there is a way. I know lots of people who wouldn't seem to have the means to pay for this surgery who somehow find a way...God opens doors for all of us. My two cents.... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 Hi , You are right, God does open doors just when we need it. I'm happy for you that you were able to the get surgery on the last day no less - what a blessing! Congrad on the 108 lb loss! S. > I agree with that statement! God opened doors for me that I didn't even know were there. I thought without insurance covering my surgery that I would NEVER be able to have this surgery. But I'm now just over 6 months post op. Not only was that door opened and my life changed.... I was in the VERY last group of people (there were four of us that day) that had surgery since this all started. March 29, 2001 was the very last day that Dr. R has performed these surgeries. So not only did God provide the funds for me to have this surgery, He also allowed my surgery to be carried out on 3/29/01. If I had been scheduled even a day later, then I wouldn't have been able to have it like so many others. Don't think I haven't thanked God for that miracle! I feel very fortunate. I prayed about this surgery for a long time, and God does answer prayers! Hugs, in OK MGB 3/29/01 -108 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 This is correct.....he said the same thing yesterday, that he was in fact cleared by the FBI! After all that #$%@ negatvive publicity...the media SHOULD print a retraction, but we all know if they ever do, it'll be buried in the back pages somewhere! wrote: > Dr. Rutledge told me that the FBI had cleared him of any wrongdoing on the insurance front. > Well, . I don't know that I'm going to be much help to you. All I know > is that there was a problem with the way he was coding stuff for the > insurance companies. My understanding is (and someone correct me if I'm > wrong) that there is not a code for the MGB. So Dr. R was using the code for > RNY and then attaching a detailed description of the procedure. Not his > fault if the insurance companies don't look at that. Anyway, our friend (HA) > T. brought this to the insurance companies attention in an effort to > cause trouble for Dr. R. Well, we see the result. > > Like I said, if this isn't right, someone PLEASE correct me. But this is my > understanding of it all. > > Congratulations on your 167 pound loss. That's GREAT! Are you still losing > or have you been where you're at for a while? > > in OK > MGB 3/29/01 > 303/195 -108 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 , I would have gone with another Dr who did accept insurnace. My husband is thinking of having a WLS, and we are considering of going with someone locally who does the lap RNY(same Dr who did LT's revision), or wait on one of the Dr's who is doing the MGB to get a few more procedures done, but we won't be going to Dr R since he doesn't accept insurance. I have a feeling that there will be more people who will be doing the same. Maybe Dr R will find enough patients that have the money to pay cash, maybe not, time will tell I guess. Manda > I don't think they have the means at all, I think they sacrifice their > homes, retirement accounts, credit rating, etc., and ability to pay other > bills. I believe the sacrifice is worth it and I would have done it to save > my life. however, coming up with funds and having the means are usually at a > great sacrifice somewhere else in their lives. Spoken as a single parent > for many years who found a way on a daily basis. > > Re: paying customers > > > I think there are two reasons that he is not going to take insurance any > more. > > 1. The hassle of applying, fighting denials, then filing, etc. take up too > much time and manpower. It makes too much overhead and too many headaches > in his practice. > > 2. Insurance companies these days pay only a percentage of what doctors and > hospitals charge, often only a small fraction, and the docs and hospitals > have to accept whatever they pay and, especially in the case of hospitals, > it often does not even cover their costs. > > The return on the effort of collecting insurance is quite often not worth > it, especially when you have more patients than you can handle. I know it > does not seem fair, but that is life under the new insurance practices. > > Pat Eppler > paying customers > > > Why is he is not taking insurance cutomers. Why is he making anyone file > with the insurance company for a refund. Why does everyone have to pay up > front. If my insurance would not have paid for my surgery, I would still > be > 276 or more at this date. I could have never come up with that type of > money. Some one please make me understand. > > > Wills > -120 > pending PS approval > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 T had to ruin a lot of lives with her evil self. But yes, life is a series of doing what is the next best thing (so my therapist says) so go for it and make due with what 'cha got! Re: paying customers > > > I think there are two reasons that he is not going to take insurance any > more. > > 1. The hassle of applying, fighting denials, then filing, etc. take up too > much time and manpower. It makes too much overhead and too many headaches > in his practice. > > 2. Insurance companies these days pay only a percentage of what doctors and > hospitals charge, often only a small fraction, and the docs and hospitals > have to accept whatever they pay and, especially in the case of hospitals, > it often does not even cover their costs. > > The return on the effort of collecting insurance is quite often not worth > it, especially when you have more patients than you can handle. I know it > does not seem fair, but that is life under the new insurance practices. > > Pat Eppler > paying customers > > > Why is he is not taking insurance cutomers. Why is he making anyone file > with the insurance company for a refund. Why does everyone have to pay up > front. If my insurance would not have paid for my surgery, I would still > be > 276 or more at this date. I could have never come up with that type of > money. Some one please make me understand. > > > Wills > -120 > pending PS approval > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 shelley, been at this loss since 11/2000. thanks for the info on Dr. R..I know how these insurance companies are when I had my appeal for coverage and lost. gary Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 10, 2001 Report Share Posted October 10, 2001 When I had to decide about my surgery, the total of Dr. R and hospital was about the same as the deductible for other doctors. Our local doctor's total package runs about $50,000 if you have no untoward complications!! Docs like him are probably why insurance companies try to get out of paying!! Pat Eppler paying customers > > > Why is he is not taking insurance cutomers. Why is he making anyone file > with the insurance company for a refund. Why does everyone have to pay up > front. If my insurance would not have paid for my surgery, I would still > be > 276 or more at this date. I could have never come up with that type of > money. Some one please make me understand. > > > Wills > -120 > pending PS approval > > > Quote Link to comment Share on other sites More sharing options...
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